MISS SHERVONNE SIMONE SUPERVILLE M.D.
NPI 1801571369
Student in an Organized Health Care Education/Training Program in Jackson, MI

Q: What is Shervonne Superville's NPI number?

The NPI number for Shervonne Superville is 1801571369. It was assigned to this individual provider in the NPPES registry on June 21, 2023.

Q: What is Shervonne Superville's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since June 21, 2023PECOS Enrolled

205 N EAST AVE, HENRY FORD ALLEGIANCE HOSPITAL, JACKSON, MI 49201(517) 205-3998 Get Directions Write a Review

NPPES record last updated: August 29, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 29, 2023, Aug 21, 2023, Jun 21, 2023 (3 updates tracked since 2023).

On this page

About Miss Shervonne Simone Superville M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS SHERVONNE SIMONE SUPERVILLE M.D. (NPI 1801571369) is an individual student in an organized health care education/training program in Jackson, Michigan, licensed in Michigan (4351050948) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1801571369

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameMISS SHERVONNE SIMONE SUPERVILLECredential: M.D.

Location Address205 N EAST AVE, HENRY FORD ALLEGIANCE HOSPITALJackson, MI 49201

Mailing Address205 N East Ave, Henry Ford Allegiance HospitalJackson, MI 49201 · (517) 205-3998

Phone(517) 205-3998

Sole ProprietorNo

Enumeration DateJune 21, 2023

Last NPPES UpdateAugust 29, 20233 updates tracked since enumeration

NPPES CertifiedJune 21, 2023

✔ NPI 1801571369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351050948

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

205 N EAST AVE, Jackson, MI 49201

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miss Shervonne Simone Superville M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Leave this field empty

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SAMANTHA RENE DANEK PA-C

Physician Assistant